International policies for achieving safe motherhood: women's lives in the balance.

Every minute of every day somewhere in the world one woman dies during pregnancy or childbirth and eight newborns die, which is a great loss to families and to societies. Nearly two decades of global efforts to promote safe motherhood and newborn health have led to several conclusions as to why these unnecessary deaths of women and newborns continue, especially in the developing world. Healthy women are needed for healthy newborns and families, yet attention to the health of women, especially during childbearing, has received minimal or no attention at country and lo cal levels where policies seem to ignore the value of the girl-child, women and newborns. One of the most important interventions proven to promote safe or healthy pregnancy for women and their newborns is the availability of skilled care--the combination of an accredited health professional with midwifery skills working in an well-equipped environment at the community level, supported by the political will needed to save the lives of mothers and babies. Yet skilled care is missing from nearly half of the world's women. This article describes the reasons for the continuing high rates of maternal and newborn deaths, key lessons learned about how to prevent such deaths based on the best available evidence, and the need for evidence-based policies directed at achieving safe motherhood for each woman who becomes pregnant and for her newborn.